Ileostomy: What is it? When is it necessary? Stoma Types, Complications and Management

We are talking about a surgical procedure in which a portion of the ileum is exposed through an opening.

During an ileostomy, healthcare providers remove or disconnect your colon (large intestine) and sometimes part of the last section of your ileum (last section of your small intestine).

If your colon or ileum is diseased, doctors can remove it. If they are injured, they may disconnect them for a short time while they heal.

Your healthcare provider will bring the end of the ileum through the abdominal wall. This makes an opening, called a stoma, for stool and mucus to pass out of the body.

When is an ileostomy needed?

Ileostomies are formed to temporarily or permanently stop digestive waste from passing through the entire length of the small intestine or colon.

There are several reasons this may be necessary, including:

  • To allow the small intestine or colon to heal after surgery, for example if a section of the intestine has been removed to treat bowel cancer.
  • To relieve inflammation of the colon in people with Crohn’s disease or ulcerative colitis.
  • To allow complex surgeries to be performed on the anus or rectum.

Before you have an ileostomy, you will usually see a stoma nurse to discuss exactly where you would like your stoma to be (usually on the right side of your abdomen) and to discuss living with a stoma.

Types of ileostomy

There are 2 main types of ileostomy:

  • Loop ileostomy : A loop of the small intestine is removed through an incision (incision) in your abdomen, before it is opened and sewn to the skin to form a stoma
  • Final ileostomy – where the ileum is separated from the colon and pulled through the abdomen to form a stoma

Alternatively, it is sometimes possible to create an internal pouch that is connected to your anus (ileo-anal pouch).

This means that there is no stoma and that the stool is expelled from its back passage in a similar way to normal.

Final ileostomies and ileo-anal pouches are usually permanent. Loop ileostomies are generally intended to be temporary and can be reversed during an operation at a later date.

After surgery

You may need to stay in the hospital for up to 2 weeks after an ileostomy operation.

During this time, a stoma nurse will teach you how to care for your stoma.

Recovering from the procedure can be challenging. Many people experience short-term physical and psychological problems, from irritation of the skin around the stoma to feelings of anxiety and self-awareness.

But with the practice and support of a nurse trained in stoma care, many people adjust and often find that their quality of life improves after surgery.

This is especially true if they have been living with a condition like Crohn’s disease for years.

Complications

As with any surgical procedure, an ileostomy carries a risk of complications.

Some of the problems that people with an ileostomy experience have include:

  • An intestinal obstruction: where the exit of digestive waste is blocked.
  • Vitamin B12 deficiency : caused by the removal of part of the intestine that absorbs vitamin B12.
  • Stoma problems – such as a change in the size of the stoma that makes it difficult to put on the outer pouch.

Managing your stoma

Lifestyle tips

Diet
  • Immediately after surgery, you will be on a restricted diet for your speedy recovery.
  • For the first few days after your recovery from surgery, you should be able to return to a normal, healthy diet unless otherwise instructed.
  • It is very important that you eat slowly and chew your food thoroughly to avoid food blockages in the intestine.
  • Drink at least 2 liters of liquid per day, or as directed by your doctor.
Clothing

After surgery, many people worry that the pouch is visible under their clothing. Don’t be too worried about it.

You should be able to wear the same type of clothing that you were wearing before your surgery. In fact, today’s bags are so thin and so close to the body, no one will likely know you’re carrying a bag unless you tell them.

The bag can be worn inside or outside your underwear, whichever is more comfortable. Women can wear pantyhose or girdles.

As with any surgery, you will need some time to recover.

You should check with your doctor before returning to work or beginning vigorous activity.

Don’t limit your activity. You should be able to go back to work or travel anywhere.